I intend to write in detail about my perspective of Handsome’s inpatient experience after he returns home, but in the interim I thought it might be useful to someone to put some of this down in my blog right now. I should clarify up front that although Handsome is a sex addict, he went to inpatient care for his mood disorders, trauma, and to endeavor to manage his medications including new medication for ADHD.
In no particular order, here are things I wish I knew beforehand:
1. I did not know that he would have extensive contact with women. While he is not in an SA program, the fact that he’s a SA is woven throughout the intake materials. The facility did put him in the housing unit for men, but that is also where they put all the women who create too much trouble in the women’s housing unit or the co-ed housing unit. (That fact continues to blow my mind.) His daily group meeting was also 6 women, plus Handsome and one other guy. Handsome is over two years sober, and by the account of his therapist he maintained good boundaries, but I’m told it’s not unusual for these process group folks to keep in contact after they leave. That’s awkward since one of our boundaries involves Handsome not texting, emailing, or calling women outside of work, childcare, or relatives.
2. I did not know how little time he would have to communicate with anyone. I knew he’d be on literal lock down when he checked in, but I figured things would loosen up afterwards. Not really. In the 3rd week he earned the ability to use his cell phone 2x day for about 20 minutes. Given that one of those sessions is when I’m at work and the kids are at school, that leaves 20 min or less a day to read some news, take care of “life stuff”, work, and family. And that’s only if the class he has before his media time ends on time.
3. I did not realize how iffy a discharge date can be. We were under the impression that Handsome was pre-approved for 30 days. Nonetheless, on day 25 the insurer did a review and could have cut off his coverage that day. They didn’t – and in fact they authorized an additional week of treatment – but Handsome watched others in his unit get sent packing early because their insurance ended coverage earlier than expected. (People were pulled out of meals and classes and told “Hey, your insurer cut you off so you can switch to self-pay or you will be discharged right now.” Like pack-your-bag-and-don’t-say-good-bye-to-anyone kind of right now.) My advice? Don’t buy a return ticket that isn’t easily refundable or changeable.
4. I did not know how hard the limited communication he could have with us would be on me (and at least one of my kids). I’m not sure what I expected, but the first two weeks he sounded miserable. Angry. Withdrawn. He actually sounded worse than before he left. I hadn’t expected that, and it was awful and disheartening. I cut our calls down to once a week (just me, he could still call the kids). It didn’t help. I’m not sure if I was expecting to hear something that I didn’t hear or if he was just drugged (they were certainly adjusting his meds regularly) but I ended up being a ball of anxiety after each call. My daughter held out a bit longer and then asked me if she had to do the calls. I asked her to try once a week. Handsome was devastated, but it might have been the wake up he needed because things seemed to turn a corner after that.
5. I did not know what an IOP is. If you’re like me, an IOP is an intensive outpatient program. After an inpatient program, they like to discharge patients to the care of an IOP as a step-down process. Broadly speaking, most are about 3 hours a day, 4 to 5 days a week. It sounds like it would be helpful BUT the burden of finding such a program seemingly falls to the family at home and, to a lesser extent, on the patient’s home therapists. Through my involvement in that research I learned a lesson about the single biggest issue with IOPs. If your loved one is coming out of an inpatient program, especially a good one with highly trained staff, they are likely to be (at best) gravely disappointed and (at worst) possibly set back by the way many IOPs are run. Very often there is no discernment between substance and process addictions so the treatment isn’t individualized. Also, it seems to be the case that much of the care is provided by interns working towards their degrees. After investigating every option within a 50-mile radius of our home, Handsome’s therapists opted to develop a Plan B – a custom plan that they would coordinate among themselves that would involve individual, group, and marriage counseling as well as EMDR. I am honestly not sure how well this will work, but time will tell.
More to follow…
I have been in the healthcare business my entire life. After watching a friend, who was fired from his high level corporate job about 2 months into his 22 year old son’s inpatient addiction (alcoholism) treatment program, become consumed with navigating all the immediate-, short-, and intermediate-term issues, I became convinced there is a huge opportunity for an enhanced EAP program that helps families of addicts navigate through the process. He is a healthcare executive but got most of his referrals and information from social acquaintances who also had alcoholic kids, and Alanon. And I told him all the time there is no way he could have performed in his job with all the issues that needed constant and sometimes immediate attention, including legal, financial, facility selection, etc. What he went through and what you describe is an economic issue in addition to all the human, emotional issues families have to find their way through. You are smart and resourceful and determined and it looks like you’re managing ok, but so many people are lost and everyone in the family suffers in ways that could be irreversible. Employers really need to provide a way for their employees to be able to maintain some level of productivity while going through these things.
I hope his program makes a difference. Your last post, though, suggests to me you might be open to the idea that all the attention you have to pay him is sucking the life out of you, and maybe you would be better off without him if he doesn’t change in observable ways soon.
I agree with you that the concept of an enhanced EAP program has a lot of merit. It was time consuming and confusing for us and so yes, I am certain it is overwhelming for many. And I am mindful that while we were sorting it out I did not have to worry about whether my loved one might OD and die if it took us too long. It was a vitally important choice for us, but not life or death in that moment as it is for many families. That has to be unbelievably stressful.
I think that I am at the point where staying and trying to help make my husband’s life better is taking a clear toll on me. The truly sad… frankly tragic… thing is that he isn’t an SA who insists that he’s not and who lives in denial. He’s not a guy who skips therapy or meetings. He tries and he puts in effort. He has a long period of sobriety. Nonetheless, it’s still a roller coaster and it remains to be seen whether he can marshall his resources to overcome the damage and brokenness that he brought with him out of his childhood. I’ve stayed this long because he has tried so diligently and his pain and anguish at the things he does are palpable. He knows he’s broken. I see it clearly too. I’m both sympathetic and I can empathize, but I can’t be on this roller coaster forever. I am cautiously optimistic about his return from rehab, so we’ll see what that brings.
xo
“..life or death in that moment as it is for many families…”
This is what we dealt with. 911 responds. The suicidal person is taken to the CLE Clinic. (and at this point, I call them out, by name – I am disgusted with them). The 1st time my husband called 911 (suicidal) – he was admitted to a locked psych unit, and I was told he’d be on “suicide watch” via a camera. Guess what? He used his socks to tie around his neck in the unit and he passed out and hit his head (didn’t die). NO ONE KNEW. NO ONE NOTICED. I only noticed when he got out in daylight when they released him (I knew he wasn’t stable, and the doc wouldn’t listen to me). I SAW his yellow bruises, then, in daylight, around his eye and he told me what he tried to do. SHIT. I drove him home (I was still in trauma – just managing the situation – he had confessed his betrayals in the few days preceding his call to 911 – wanting to die).
A few days later, after his release, he was in an IOP, and he became psychotic at home, and left our home early in the morning (when he wasn’t supposed to be leaving, so I heard him – garage door). I found him, in his car, a few miles away from home, almost dead. Three modes of suicide happening at once, and I ran around the car with my cell in my hand (911 on the phone – I was pleading for their help) and I was able to stop his attempt. He lived. 911 took him right back to CLE Clinic, and he was in a different, locked psych unit.
I only share my story (abbreviated) to say – um, yep, I am very frustrated with the system and with an IOP. The personnel at the IOP wrote a suicide plan with him the day before he tried to die b/c they noticed something was”off” – well – did they bother calling HIS WIFE? Give her “heads up”? Nope.
I know your situation is different, BA.
I wish care for people with mental health issues would improve. SIGH.
They wrote a suicide plan with him and didn’t bother to loop you in? That’s terrifying. I’m so sorry you both went through that.
And here’s an interesting factoid – the public often presumes/ assumes that mental health issues really primarily impact the poor or uneducated. Roughly half of the folks in Handsome’s program are doctors and other professionals. Half. Yes, someone could say “well, inpatient is expensive or requires good insurance so of course those folks are going to be over-represented there.” There is likely truth to that. It is also, however, likely true that even that group of people could not find adequate support outside of an inpatient setting. That’s sad, and it bodes terribly for those without good resources.
xo
xo
Yes – I was NOT notified of the suicide plan at all. The Cleveland Clinic ran the IOP.
Finding adequate support and care has been such a challenge. I hope the program your husband is in will help him, which can help the relationship.
Yes, it makes me very sad about people with less resources b/c mental health issues do not discriminate across earning abilities.
Hang in there.
A very insightful, poignant post, BA. And good points explored by you and B.
I wish you all well as you keep forging on along this very difficult path xxx
Personally, I think same sex therapy groups are generally better. You are disclosing a lot of personal stuff, and being there for people who disclose a lot of personal stuff to you. Well that might be absolutely fine for some people, I can see how it could also lead to emotional bonding and closer relationships than are really appropriate – especially if they maintain contact after rehab ends. Obviously your husband will be bound by confidentiality, and cannot share with you the details of others’ lives. However, I hope he is able to be open with you about pretty much everything that came up for HIM during these sessions. you should always be the person who knows the most about him …
Absolutely! 👏🏻 There were a number of comments about the amazing and incredible “people” in his group which is what prompted me to ask about women. I have to wonder if he wasn’t getting some hits out of those sessions. Regardless, my boundary is firm. I hope those folks helped them and I wish them well, but those aren’t ongoing relationships in my book.
Xo
No, I would have to agree with you here blackacre. There are ethical guidelines which prohibit counsellors and therapists getting into romantic relationships with clients. One of the reasons those guidelines exist is it’s recognized that emotional openness can lead to a feeling of emotional closeness and, sometimes, sexual attraction. I suspect that no such boundaries exists between group members after they leave the group – and that would raise alarm bells for me.
I have some real thoughts here, but the internet is down and typing on my phone, which I’m doing now, makes me want to hang myself. I’ll have a much longer response when Comcast gets its act together.
First off, he’s not a drug addict who needs to be tested and monitored daily, so don’t worry about the IOP. I was also an alcoholic and left mine after three days. It was pointless compared to the care I got in rehab. This is going to make me sound horrible, but it’s a much lesser level of care for people who can’t afford rehab. It’s going to be packed with people he probably can’t relate to and would never be around in real life. I mean, do what you want, but I’d never put anybody with a process addiction into one of those situations.
I’d say you should have checked about the communication with the outside world, but they can change their rules as much or as little as they want and never let you know. The other side of that is that he’s in a place where the less contact with the outside world, the better. It’s great to hear from your loved ones, but many of the time I made those calls, it was out of obligation. It’s impossible to explain that culture and day-to-day life if you haven’t done it, but it’s nothing at all like the real world. Being reminded of the real world isn’t always the healthiest thing at that moment.
Unless he’s in just a sex addict clinic, he’s dealing with people who have other addictions as well and that includes women. Much of the time, he’s probably isolated with men or those who have his specific malady, but at both rehabs I attended, there was a mixing of groups. If one is going to learn to function in the world, they need to learn to function around other people. I had a daily processing group that was three older women (50-60) who were alcoholics, a male sex addict (45-50), and two drugs addicts, one male, one female, both probably 25. This was one of my favorite groups because it was nice to see that regardless of age, gender or addiction, we had so many of the same issues. I wouldn’t have got as much out of that group if it was just men my age who were porn addicts.
Yes, many people do stay in touch after rehab. I kept in touch with about five people, men and women, from my first rehab, for a couple months, but it stopped. At my second rehab, I stayed in touch with more women from the eating disorder program than anybody else. For some reason, we clicked and they understood my struggles. But, the contact stopped fairly quickly, maybe 3-4 weeks. Transitioning out of rehab is tough. You work 24/7 on becoming a better person, utilizing tools to have a better life and working on previous trauma. You’re around other sick people and strangely, it all makes sense while you’re there. You cry and emote with them, you celebrate with them, you get angry and sad and have this very unique experience. You need to appreciate that he’s going through something very major and it’s a shock to come home to the same place and the same people who either expect you to be magically “fixed” or expect you to the be the same guy. Neither happens. Being able to lean on the people who were in that same experience with him can be an important source of support, even if they happen to have a vagina. Why do you think so many people in war together keep in touch years later? It’s a shared experience that you can’t understand unless you were there. It’s not quite foxhole-level at rehab, but to just detach from those people and be thrown back into the world is scary. I know, I’ve done it twice.
And, even if you’re totally open to the idea of rehab, it’s going to be horrible in the beginning. Rehab happens in three stages. First, they tear you down. It’s very negative. It’s about your bad choices, the bad things that happened to you, the bad things you’ve done to others and the recognition it has to change. The middle part is about unlocking some of the keys to recovery, starting to figure things out and starting to feel healthy. The last part is where you actually start to feel like you’ve got it together and can face the world. I thought I was going to 28 days of rebab my first time. I spent 70 there. The second time, I made sure to ask and they were upfront the average person’s stay was 60 days. I completed the program in 49 days. I don’t think a certain timeline structure is a wise move as we all are different. I’m sure 30 days is perfect for a few people out there, but for most, it’s not enough time.
I hope I haven’t offended with any of this. It’s merely my experience and witnessing the experience of others.
I think I saw the stages you describe – or heard them more accurately – in my few calls with Handsome. Four weeks would not have been enough for him. In his case, the end of the 4th week and into the 5th week seems to be where he had the most progress and growth. That said, if all someone can afford is 30 days or that’s all their insurance will cover, I would have to think it’s better than not going at all.
I appreciate your comments about the IOPs too. Your insight is kind of what I figured, but when there’s some professional saying “we always discharge people to an IOP program” you assume it will be helpful. I think the plan being cobbled together with meetings, therapy, and EMDR will likely be much more beneficial and more impactful in less time.
If I had to do it again (hoping I never do) I might prefer to go cold turkey on the calls. I’m sure they were often obligatory for him and for me they were often crushingly painful. Good old fashioned letters would probably have been better. I knew it would be hard for him to reach out, but the facility talked about access to pay phones and email. I should have asked more details on that. It didn’t occur to me that there would only be one pay phone and one computer for 40 folks in his housing unit. Knowing that, I give him credit for being as consistent as he was with the calls.
My sense on the communication with his group is that it will die off over time. Handsome is a crappy communicator, generally. There is no one in his life from the first 35 years of his existence. He just doesn’t keep up with people. That said, it is troublesome to me that he would have ongoing communication with women from his group. The fact that our CSAT is troubled too leads me to believe that I’m not totally off base here. A part of my husband’s addition was daily texting and communication with women who he maybe only saw in person for a few hours over the course of years, but yet he built relationships with them via text. (There were two emotional affairs that did not involve sexting or sex.) These women didn’t need to be near or accessible to him. It’s no comfort to me that the women in Handsome’s group live far from us. As Handsome built his emotional affairs, he confided and invested time in those affair partners and withdrew efforts from our marriage. I don’t have any desire to recreate that scenario, and all of the groundwork is already in place (precisely as you said, the bonding over the shared experiences). Ultimately though, it’s a decision he should be able to make on his own. He knows what he did before. If he feels comfortable holding his hand really close to the flame again, I can’t stop him. I can simply observe his behavior and make decisions about my well being and that of my kids based on his actions instead of his intent. He asked me if I would consider going on vacation with some people from his group. I said “sure, why not” thinking that there isn’t a snowball’s chance in h$ll of that ever happening. If I’m wrong? Then we spend a few extra days visiting my friends from the blogospere too. 🙂
Great…you can come up to Maine and buy my wife and I dinner!
You’re absolutely right about communication dropping off as it sounds like your husband is about as good as I am in keeping in touch with people. It’s just nice to know there’s a crutch there when the real world gets too challenging early on. I see a few of the people who I went to rehab with in my phone and realize it’s been nearly four years since I talked to 95% of them and haven’t had a word with one in over two years. I wouldn’t know what to say to them now. The other thing that sucks about staying in touch with your former addict friends is not all of them end up as former addicts. Many go back and it’s just sad.
No, you’ll never go on vacation with the rehab gang and after a few weeks out, he’ll realize that too. He’ll come to realize he doesn’t want to. I think the best way to deal with someone fresh from rehab is almost with kid gloves, allowing them to come to the conclusions you’ve already reached. It’s easier and less confrontational. My rehab crews were the first bunch of new friends I’d made in two decades who didn’t immediately want something from me. It’s a nice feeling, and it’s easy to lose sight that it’s a unique, controlled environment. You can be friends with people 20 years older or younger than you in there…but you’re not going to have anything in common on the outside. And most of them have significant others who would laugh at the prospect.
As I was more porn and he was more general sex, with this history, the CSAT probably has a point, but I like what you said about not being able to control him. That’s incredibly healthy on your end and I wish more partners could internalize that. As I’ve been knee-deep in partner issues since the book came out, it’s very hard to get a lot of partners to realize that recovery is not suddenly that you are the master and they are the pet.
And you are 100% correct in that a little rehab is better than no rehab at all.
Ha! Lobsters it is then. 🙂